Hepatocellular Carcinoma in Hepatitis C-Associated Cirrhotic Patients Treated with Different Combinations of Direct-Acting Antiviral Agents Available in Pakistan: A Prospective Observational Study

Background: The hepatitis C virus (HCV) is a leading cause of chronic liver disease, including hepatic cirrhosis and hepatocellular cancer (HCC). Drugs that act directly on the virus, like as direct-acting antivirals (DAAs), are associated with improved long-term virologic responses and reduced treatment time. Pakistani patients with HCV-related cirrhosis receiving DAA medication were studied to see if they had an increased risk of hepatocellular carcinoma (HCC). Material and Methods: We conducted a prospective observational study at Isra University Hospital Hyderabad from July 2019 to August 2020. Three hundred fourteen patients met the inclusion criteria and were included. We recorded baseline demographic characteristics, Child-Pugh class, model for end-stage liver disease (MELD) score, alpha-fetoprotein level, and abdominal ultrasound/computed tomography (CT) scan before and after treatment. Results: Three hundred-fourteen individuals took part in the research. The average age of participant with hepatocellular carcinoma was 46.7 years. Twenty (sixty-nine) of the participants developing hepatocellular carcinoma were men, while nine (thirty-one percent) were women (p=0.221). Five (17.2%) of the HCC participants were diabetics, and seventeen (58.6%) were tobacco users (p=0.001). Twenty individuals (69%) developed HCC after receiving a combination of sofosbuvir and daclatasvir. A sofosbuvir/velpatasvir combination led to the development of HCC in nine (31%) of individuals (p=0.1). HCC was diagnosed in eight individuals under the age of forty (27.6%), but in 21 patients beyond the age of forty (72.6%) (p=0.55). HCC was found in 65.6 percent of Child-Turcotte-Pugh class A participants. Conclusion: DAAs have been linked to a higher risk of HCC. Participants receiving a combo of sofosbuvir/daclatasvir were more likely to develop HCC than those who received sofosbuvir/velpatasvir alone. Keywords: Velpatasvir, Hepatocellular carcinoma, Sofosbuvir, Cirrhosis,

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Assessment of Liver Stiffness Regression and Hepatocellular Carcinoma Risk in Chronic Hepatitis C Patients after Treatment with Direct-Acting Antiviral Drugs

Medicina ◽

10.3390/medicina57030210 ◽

2021 ◽

Vol 57 (3) ◽

pp. 210

Author(s):

Martynas Ridziauskas ◽

Birutė Zablockienė ◽

Ligita Jančorienė ◽

Artūras Samuilis ◽

Rolandas Zablockis ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Liver Stiffness ◽

Direct Acting Antiviral ◽

End Of Treatment ◽

Increased Risk ◽

Patients With Diabetes ◽

Direct Acting

Background and Objectives: Chronic hepatitis C virus infection affects about 71 million people worldwide. It is one of the most common chronic liver conditions associated with an increased risk of developing liver cirrhosis and cancer. The aim of this study was to evaluate changes in liver fibrosis and the risk of developing hepatocellular carcinoma after direct-acting antiviral drug therapy, and to assess factors, linked with these outcomes. Materials and Methods: 70 chronic hepatitis C patients were evaluated for factors linked to increased risk of de novo liver cancer and ≥ 20% decrease of ultrasound transient elastography values 12 weeks after the end of treatment. Results: The primary outcome was an improvement of liver stiffness at the end of treatment (p = 0.004), except for patients with diabetes mellitus type 2 (p = 0.49). Logistic regression analysis revealed factors associated with ≥ 20% decrease of liver stiffness values: lower degree of steatosis in liver tissue biopsy (p = 0.053); no history of interferon-based therapy (p = 0.045); elevated liver enzymes (p = 0.023–0.036); higher baseline liver stiffness value (p = 0.045) and absence of splenomegaly (p = 0.035). Hepatocellular carcinoma developed in 4 (5.7%) patients, all with high alpha-fetoprotein values (p = 0.0043) and hypoechoic liver mass (p = 0.0001), three of these patients had diabetes mellitus type 2. Conclusions: Liver stiffness decrease was significant as early as 12 weeks after the end of treatment. Patients with diabetes and advanced liver disease are at higher risk of developing non-regressive fibrosis and hepatocellular carcinoma even after successful treatment.

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Occurrence of hepatocellular carcinoma in patients with hepatitis C virus related liver disease treated with direct-acting antivirals

Journal of Hepatology ◽

10.1016/s0168-8278(17)30309-4 ◽

2017 ◽

Vol 66 (1) ◽

pp. S23-S24 ◽

Cited By ~ 3

Author(s):

V. Calvaruso ◽

G. Cabibbo ◽

I. Cacciola ◽

S. Petta ◽

S. Madonia ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis C Virus ◽

Liver Disease ◽

Hepatitis C ◽

Direct Acting Antivirals ◽

Related Liver Disease ◽

Direct Acting

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Is direct acting antiviral therapy for hepatitis c viral infection associated with increased risk of hepatocellular carcinoma before or after liver transplantation?

HepatoBiliary Surgery and Nutrition ◽

10.21037/hbsn.2019.05.10 ◽

2019 ◽

Vol 8 (5) ◽

pp. 563-565

Author(s):

Ashokkumar Jain ◽

Danielle Miller ◽

Zakiyah Kadry

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Hepatitis C ◽

Viral Infection ◽

Antiviral Therapy ◽

Direct Acting Antiviral ◽

Increased Risk ◽

Direct Acting

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No increased risk of hepatocellular carcinoma recurrence in patients following interferon-free, direct acting anti-viral treatment for hepatitis C virus: a cohort study using large-scale administrative medical claims data

Journal of Hepatology ◽

10.1016/s0168-8278(17)31469-1 ◽

2017 ◽

Vol 66 (1) ◽

pp. S533 ◽

Cited By ~ 2

Author(s):

L.E. Telep ◽

D. Muramoto ◽

A. Osinusi ◽

D.M. Brainard ◽

K.R. Reddy ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Cohort Study ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Large Scale ◽

Claims Data ◽

Medical Claims ◽

Increased Risk ◽

Hepatocellular Carcinoma Recurrence ◽

Direct Acting

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Increased risk of hepatocellular carcinoma after hepatitis C direct-acting antiviral drugs: the threat that never was

AME Medical Journal ◽

10.21037/amj.2018.03.01 ◽

2018 ◽

Vol 3 ◽

pp. 38-38

Author(s):

Julie Zhu ◽

Trana Hussaini ◽

Eric M. Yoshida

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis C ◽

Antiviral Drugs ◽

Direct Acting Antiviral ◽

Increased Risk ◽

Direct Acting

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Hepatitis C: An Overview

10.5772/intechopen.94879 ◽

2021 ◽

Author(s):

Syed Manzoor Kadri ◽

Marija Petkovic

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis C ◽

Sexual Transmission ◽

Therapeutic Modalities ◽

Increased Risk ◽

Promising Treatment ◽

Health Care Performance ◽

Direct Acting ◽

Acid Test ◽

Liver Infection

Hepatitis C virus (HCV) has infected approximatelly 130–170 milion individuals in the form of chronic liver infection and hepatocellular carcinoma. In the majority of patients with the increased risk for hepatocellular carcinoma the initial rearrangement is fibrosis. HCV is a bloodborne virus. The most common route of the infection are drug use, injections, unsafe health care performance, transfusion and sexual transmission. The incubation period ranges from 2 to 6 weeks in case of HCV. HCV infection is diagnosed in the process of detecting of anti-HCV antibodies and if positive, a nucleic acid test for HCV ribonucleic acid (RNA) is done. Currently, the most promising treatment agents are direct-acting antivirals (DAAs). They have shown limited viral resistance, long treatment duration and higher cost with no proven benefits in the prevention of graft reinfections in HCV individuals. In the light of the aforementioned, there is a need to a more dubious research in the quest for the effective therapeutic modalities.

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